Outline

Objective: To report two cases of a rapid onset of acute rhabdomyolysis after initiation of the medical treatment with phenytoin in symptomatic epilepsia, along with detailed blood chemistry findings and therapeutic management.

Methods: Acute rhabdomyolysis is a life-threatening disorder, that can be triggered by various causes. Pathophysiologically it is an immuno-allergic reaction affecting the skelettal muscles with pathognomonical features of its clinical appearance and blood chemistry findings, leeding to severe disability or death in worse cases. Rhabdomyolysis has been described before in the treatment with phenytoin, developing several weeks after its first administration. Two patients in our clinic presented clinical signs of acute rhabdomyolysis after initiation of anticonvulsive treatment with phenytoin, that was confirmed in blood chemistry findings.

Results: Blood chemistry revealed acute rhabdomyolysis in two patients, who were treated with phenytoin for symptomatic epilepsia. Intensive-care management with hypervolemic treatment and forced diuresis could prevent hemodialysis in both cases. Recovery was uneventful in both patients.

Conclusions: This is the first reported sudden onset of an acute rhabdomyolysis after administration of phenytoin for syptomatic epilepsia. One must be aware of this complication and it is mandatory, that routine blood examinations have to be done, when a patient is treated with phenytoin for seizure control. Acute rhabdomyolysis has to be managed by intensive-care treatment with hypervolemia and forced diuresis to prevent hemodialysis.